Dermatology is the branch of medicine that concentrates on the treatment of the skin, hair and nails, and dermatology is divided into three broad categories: medical dermatology, cosmetic dermatology, and surgical or procedural dermatology.
To some extent, these divisions are artificial, and a closer look at psoriasis can help us understand why.
Psoriasis is a disease that doctors typically think of as falling within “medical dermatology.” Psoriasis is accompanied by inflammation in the skin and in other organs of the body. In fact, patients with psoriasis are at higher risk of certain joint diseases, heart disease and other medical problems. Clearly, psoriasis is a medical problem.
However, psoriasis is also a cosmetic issue, and some cases of psoriasis fall within both medical and cosmetic dermatology. Psoriasis can be so cosmetically distressing that people avoid going out, seeing their friends, or participating in activities that they love. It is no wonder that numerous studies have linked psoriasis to depression. It would be unfair to dismiss as unimportant the cosmetic side to psoriasis. The “heartbreak” of psoriasis is real.
Finally, some types of psoriasis are being treated with lasers, and for that reason psoriasis now also may be argued to fall within procedural / surgical dermatology. Traditionally, dermatologists with extra interest in performing procedures consider a fellowship to learn how to use instruments and devices to better treat their patients. For patients with a limited number of plaques of psoriasis, sometimes lasers are the best option.
Why is Grouping a Disease in the “Right” Category Important?
Exercises like thinking about psoriasis are not just “academic.” Whether psoriasis is a medical dermatology problem or a cosmetic problem matters a lot – to patients, to doctors, to insurers, and to the numerous scientists, researchers, and others involved in helping patients who suffer with psoriasis.
First, classifying a disease properly matters because it affects whether insurance will cover its treatment. If psoriasis were dismissed as “purely cosmetic,” then insurance would be unlikely to cover its treatment.
Thankfully, insurance coverage is rarely an issue for moderate to severe psoriasis. Psoriasis has been clearly defined as a medical problem as doctors and patients have come to understand its effect on other organs. In fact, severe cases of psoriasis can even be life-threatening. If psoriasis covers enough of someone’s skin, it can cause “erythroderma,” a condition in which the skin can no longer do its jobs. The skin is responsible for helping to control someone’s body temperature, keeping the body hydrated, and thereby helping to keep blood pressure and other organ function in proper range. Not too long ago, before the miracle drugs we have today, whole wards of hospitals were taken up with patients who had severe psoriasis posing a threat to their lives. Now amazing medicines have closed these wards and allowed almost all cases of psoriasis to be treated elegantly.
Unfortunately, mild cases of psoriasis are sometimes dismissed as cosmetic, and some insurance plans do not want to cover the treatment of psoriasis that is not “moderate to severe.” These categories matter to insurance companies, and that’s one reason you hear so many commercials mention “moderate to severe” plaque psoriasis or “moderate to severe” in other contexts.
Classifying a disease properly also matters because people tend to stop thinking about medical risks if a disease is deemed “strictly cosmetic”. For example, if someone thinks that their psoriasis is just cosmetic, they may not pay attention to the pain in their joints. That pain could be from “psoriatic arthritis” – inflammation in the joints of patients with psoriasis. Most patients with psoriasis do not develop psoriatic arthritis, but it is very important to treat patients who do and to identify cases early. One of the jobs of dermatologists is to look out for trouble before it causes too much harm. Treating psoriatic arthritis early can save someone the use of their hands and more.
Treating the entire patient means taking a broad view of how a disease or concern can affect someone. If a disease can be classified as falling within “medical dermatology,” then both the disease and its accompanying problems can often more readily receive the treatment that they deserve.
I Have Psoriasis – What Can I Expect During a First Visit?
During a typical first appointment, our board-certified dermatologist will take a detailed medical history, during which he will ask about known skin problems. He will also want to know about any medications and products the patient uses. He will ask if there is a history of skin problems in the patient’s family. Some skin conditions can accompany psoriasis and can run in families. A “review of systems” is taken to ensure that there are currently no symptoms of diseases that can accompany psoriasis and that would warrant a closer look. Additional details such as a patient’s occupation and hobbies are important to note because they determine which treatments are reasonable. This is a great opportunity to share any concerns, observations and goals.
After a medical history, the dermatologist will thoroughly examine the patient’s skin. This includes examining the scalp and nails. It’s important to know exactly which areas are affected so that the correct strength and type of medicines can be prescribed. For example, most patients might be pleased with a cream or ointment for their knees but not for their scalp. In areas with hair, a foam-based medicine is usually preferable.
Upon concluding the skin exam, the dermatologist will discuss any treatment options the patient may need. If a patient decides to proceed with treatment, follow-up visits will be scheduled. There is no one-size-fits-all approach when it comes to medical dermatology; each treatment is personalized for the individual and the situation.
Do You Have Psoriasis or a Dermatologic Complaint?
From psoriasis to skin cancer and varicose veins to BOTOX®, Premier Dermatology and Mohs Surgery of Atlanta can help keep your skin healthy and happy. Schedule an appointment with our board-certified dermatologist to learn more. Our office is conveniently located off of North Point Parkway and GA Hwy 400 in Alpharetta, just north of Atlanta. Contact us today to request a consultation.